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<p>Neoadjuvant chemotherapy (NACT) is the standard treatment for locally advanced breast cancer (LABC) to make tumors operable and facilitate breast conservation surgery (BCS). While pathological complete response (PCR) following NACT is expected to improve outcomes, PCR rates are relatively low except in HER2-positive or triple negative tumors. Radiotherapy (RT), conventionally is administered post-surgery. Concurrent chemoradiotherapy (CCRT), a strategy widely used in other cancers, combines the benefits of chemotherapy and radiotherapy, potentially improving tumor control and better PCR rates. This study aimed to evaluate the safety and efficacy of neoadjuvant CCRT compared to conventional NACT in LABC patients, focusing on PCR, adverse events, locoregional control, and survival outcomes. This randomized controlled trial enrolled non-metastatic LABC patients from a tertiary hospital in North India between September 2020 and January 2024. Patients were randomized into two groups: Group 1 received CCRT (chemotherapy concurrent with RT), and Group 2 received conventional NACT. Outcomes measured included PCR, adverse events, surgical metrics, progression-free survival (PFS), disease-free survival (DFS), and overall survival (OS). Among 126 participants, 66 were allocated to CCRT and 60 to NACT. PCR was significantly higher in the CCRT group (67.8%) compared to the NACT group (40%, <i>p</i> = 0.011). Locoregional recurrence was lower in the CCRT group (3.3% vs. 10.9%, <i>p</i> = 0.383), though not statistically significant. Adverse events such as skin reactions were more frequent in the CCRT group (31.8% vs. 13.3%, <i>p</i> = 0.02), with most being mild and manageable. Kaplan-Meier analysis showed no significant differences in PFS, DFS, or OS between the two groups during a mean follow-up of 17.43 months. Neoadjuvant CCRT in LABC has higher PCR rates, manageable toxicity profiles, without difference in survival. It offers a promising alternative to conventional therapy, particularly in resource-limited settings. Long-term survival data are awaited to establish its definitive role.</p>

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Safety and Efficacy of Neoadjuvant Concurrent Chemoradiation in Locally Advanced Breast Cancer- Short-term Results of a Randomized Controlled Trial

  • 期刊论文

  • 发表日期：

    2026年1月22日

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  • Ganesh Bhat,
  • Ashwinee Rahalkar,
  • Mrinalini Verma,
  • Kul Ranjan Singh,
  • Pooja Ramakant,
  • Anand Kumar Mishra

摘要

Neoadjuvant chemotherapy (NACT) is the standard treatment for locally advanced breast cancer (LABC) to make tumors operable and facilitate breast conservation surgery (BCS). While pathological complete response (PCR) following NACT is expected to improve outcomes, PCR rates are relatively low except in HER2-positive or triple negative tumors. Radiotherapy (RT), conventionally is administered post-surgery. Concurrent chemoradiotherapy (CCRT), a strategy widely used in other cancers, combines the benefits of chemotherapy and radiotherapy, potentially improving tumor control and better PCR rates. This study aimed to evaluate the safety and efficacy of neoadjuvant CCRT compared to conventional NACT in LABC patients, focusing on PCR, adverse events, locoregional control, and survival outcomes. This randomized controlled trial enrolled non-metastatic LABC patients from a tertiary hospital in North India between September 2020 and January 2024. Patients were randomized into two groups: Group 1 received CCRT (chemotherapy concurrent with RT), and Group 2 received conventional NACT. Outcomes measured included PCR, adverse events, surgical metrics, progression-free survival (PFS), disease-free survival (DFS), and overall survival (OS). Among 126 participants, 66 were allocated to CCRT and 60 to NACT. PCR was significantly higher in the CCRT group (67.8%) compared to the NACT group (40%, p = 0.011). Locoregional recurrence was lower in the CCRT group (3.3% vs. 10.9%, p = 0.383), though not statistically significant. Adverse events such as skin reactions were more frequent in the CCRT group (31.8% vs. 13.3%, p = 0.02), with most being mild and manageable. Kaplan-Meier analysis showed no significant differences in PFS, DFS, or OS between the two groups during a mean follow-up of 17.43 months. Neoadjuvant CCRT in LABC has higher PCR rates, manageable toxicity profiles, without difference in survival. It offers a promising alternative to conventional therapy, particularly in resource-limited settings. Long-term survival data are awaited to establish its definitive role.